Red/Painful Eye :: PLAB 2 Symptomatic Differential Stations

• Acute Glaucoma

  • Other presenting symptoms: 

    • Eye pain

    • Red eye

    • Headache around the eye

    • Nausea, vomiting

    • Haloes

    • Taking amitryptiline/salbutamol

  • Past history and PMAFTOSA: 

    • Medication

    • Mood if amitriptyline

    • Asthma if salbutamol

  • Social:

    • Life effects

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, ESR, CRP

    • Eye examination

      • No fundoscopy

    • Eye pressure

  • Referral:

    • Urgent ophthal admission

  • Treatment: 

    • Painkiller, antiemetic

    • Stop/change amitryptilline/salbutamol

    • Take off sunglasses

  • Warning signs:

    • Sudden vision loss

    • Dont drive

• Optic Neuritis

  • Other presenting symptoms: 

    • Eye pain

    • Previous episodes

    • Problem differentiating colors

  • Past history and PMAFTOSA: 

    • Family history (MS)

  • Social:

    • Life effects

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods (RFT, HbA1c)

    • Eye examination

      • Light reflex

      • Eye movements

      • Fundoscopy

    • Neurological examination

    • LP

    • MRI

    • NCV

  • Referral:

    • Immediate neurology referral

  • Treatment: 

    • Painkillers

    • Steroids

  • Warning signs:

    • Sudden loss of vision

    • Weakness 

    • Dont drive

• Scleritis

  • Other presenting symptoms: 

    • Acute severe eye pain

    • Radiates to forehead/jaw

    • Red watery eye

    • Blurred vision

    • Photophobia

    • History of Rheumatoid arthritis

  • Past history and PMAFTOSA: 

    • Medication

  • Social:

    • Life effects of RA

    • DVLA, work

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods (ESR, CRP)

    • Eye examination

  • Referral:

    • Immediate ophthal referral

  • Treatment: 

    • Pain killers

    • steroids

  • Warning signs:

    • Sudden vision loss

    • Severe headache

• Bacterial keratitis

  • Other presenting symptoms: 

    • Acute eye pain

    • Red watery eye with sticky discharge

    • Blurred vision

    • Photophobia

    • History of sleeping/swimming with contact lenses

  • Past history and PMAFTOSA: 

    • Previous episodes

    • Immunocompromised?

  • Social:

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods

    • Eye examination

    • Corneal scrapings culture

  • Referral:

    • Immediate ophthal referral

  • Treatment: 

    • Pain killers

    • Eye drops

    • Intensive topical antibiotic therapy

    • Stop wearing contacts

    • Hygiene 

  • Warning signs:

    • Sudden vision loss

• Ocular herpes simplex

  • Other presenting symptoms: 

    • Acute red eye

    • Blurring of vision, photophobia

    • History of cold sores/genital ulcers

  • Past history and PMAFTOSA: 

    • Sexual history

    • Immunocompromised?

  • Social:

    • Life effects

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods

    • Eye examination

    • Corneal scrapings test

    • Cold sore/groin examination

  • Referral:

    • Immediate ophthal referral

  • Treatment: 

    • Pain killer, eye drops

    • Aciclovir

    • General measures:

      • Avoid touching the lesions 

      • Hygiene

      • Avoid contact

  • Warning signs:

    • Sudden vision loss

    • Severe headache

• Allergic conjunctivitis

  • Other presenting symptoms: 

    • Acute bilateral eye pain and itchy eyes

    • Red watery eye with slight discharge

    • Slight matting in the morning

    • Runny nose

    • History of hay fever/allergic rhinitis

    • Seasonal variation

  • Past history and PMAFTOSA: 

    • Similar episodes

    • Allergy history

  • Social:

    • Life effects

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Eye examination

  • Referral:

    • None

  • Treatment: 

    • Reassurance

    • General measures:

      • Hygiene

      • Avoid contacts

      • Avoid triggers

  • Warning signs:

    • Sudden vision loss 

• Subconjunctival hemorrhage

  • Other presenting symptoms: 

    • Sudden red eye in one eye

    • No other symptoms

  • Past history and PMAFTOSA: 

    • Medications

    • Blood disorders

    • Family history

  • Social:

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods (clotting profile)

    • Eye examination

  • Referral:

    • None

  • Treatment: 

    • Reassurance

    • Artificial tears

  • Warning signs:

    • Increasing in size

    • Loss of vision

    • Bleeding anywhere else

    • Dont take aspirin